Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-08T20:28:56.476Z Has data issue: false hasContentIssue false

Syndromes dépressifs et antidépresseurs

Published online by Cambridge University Press:  28 April 2020

V Caillard*
Affiliation:
Service de Psychiatrie (Pr Zarifian), Centre Esquirol, CHRU Côte-de-Nacre, 14033Caen Cedex, France
Get access

Résumé

L'actuel concept de dépression (épisode dépressif majeur) du DSMIII, puis maintenant du DSMIII-R, largement repris dans le projet d'ICD 10, est extraordinairement inclusif, au point de n'avoir plus guère de valeur heuristique, du moins dans son utilisation actuelle. L'approche pragmatique à laquelle il correspond, supposée a-théorique, participe en fait d'une tautologie: est considéré comme antidépresseur tout abord thérapeutique qui améliore les échelles d'évaluation de la dépression appliquées à des groupes (généralement hétérogènes) de patients classés dans cette catégorie. Vus sous cet angle, les électrochocs, les imipraminiques, les IMAO non sélectifs et non réversibles, mais aussi certaines thérapies cognitivo-comportementales, certaines benzodiazépines, tout autant que des nouvelles molécules (inhibiteurs du recaptage spécifiques, psychostimulants, certains neuroleptiques) peuvent être qualifiés d'antidépresseurs. À cet égard, le DSMIII-R ne permet pas, dans l'ensemble, de tester des hypothèses (trouver des différences) psycho-pharmacologiques. Ce qui est comparé n'est plus l'action pharmacodynamique antidépressive puisqu'elle est équivalente pour toutes les approches, mais des actions pharmacodynamiques qui rendent compte des profils d'effets latéraux. On décrit ainsi des antidépresseurs imipraminiques classiques, des substances atypiques dont certaines ont fait la preuve de leur activité antidépressive, d'autres pas (cela dépend des critères de preuve d'activité qu'on choisit d'accepter), des nouveaux antirecapteurs, pour la plupart sérotoninergiques, des IMAO globaux et irréversibles, de nouveaux IMAO sélectifs et réversibles. On peut insister dans cette façon de décrire les antidépresseurs sur les molécules qui n'ont pas fait la preuve rigoureuse d'une action antidépressive, mais qui n'en sont pas moins des molécules pharmacodynamiquement intéressantes, des «médicaments en quête d'indications». On peut aussi insister sur les inhibiteurs du recaptage de la sérotonine, dont l'intérêt pharmacodynamique majeur n'est peut-être pas l'action antidépressive, mais l'action régulatrice de la balance pondérale, l'action anti-obsessionnelle, l'action anti-impulsion, l'action anti-alcoolique, etc, mettant ainsi l'accent non plus sur ce qui rapproche ces substances des antidépresseurs, mais sur leurs propriétés originales. Le problème est l'intrication des contraintes industrielles et de l'impasse nosologique actuelle qui conduit à positionner une nouvelle molécule dans la dépression Plutôt que par rapport à des cibles pathologiques ou syndromiques plus étroites et moins ambitieuses.

Summary

Summary

The current concept of depression (major depressive episode) according to the DSM-III, now the DSM-III-R, extensively used in the ICD 10 project, is extraordinarily comprehensive to the point of having practically lost any heuristic value, at least in its current utilization. The pragmatic approach to which it corresponds, supposedly atheoretical, pertains in fact to a tautology. Is considered primarily as an antidepressant any therapy which improves the rating scales for depression applied to groups of patients (usually heterogeneous) classified in this category. From this viewpoint, ECT, imipramine-type drugs, unselective and irreversible MAOIs, together with certain cognitive and behavioural therapies, some benzodiazepines, as well as new molecules (specific uptake inhibitors, psychostimulants, certain neuroleptics) may be qualified as antidepressants. In this respect the DSM-III-R does not enable psychopharmacological theories to be tested (finding differences). It is no longer the antidepressant pharmacodynamic action which is compared, since it is equivalent in every approach, but pharmacodynamic actions which take into account the profiles of lateral effects. Described in this way are classic imipramine antidepressants, atypical substances, some of which have shown proof of their antidepressant activity, others have not (depending on the criteria for proof of activity one chooses to accept), new uptake inhibitors, mostly serotoninergic, global and irreversible MAOIs, and new selective reversible MAOIs. By this way of describing antidepressants, some of the molecules have not shown rigorous proof of antidepressant action, but are none the less pharmacodynamically interesting - “medicines in search of instructions”. Emphasis may also be laid on serotonin uptake inhibitors, the major pharmacodynamic interest of which is perhaps not antidepressant action, but regulatory action of the ponderal balance, anti-obsessional action, anti-impulsive action, anti-alcoholic action, etc, thus no longer putting the accent on what links these substances to antidepressants, but on their original properties. The problem lies in the intricacy of industrial constraint and the current nosological “cul-de-sac” which entices one to aim a new molecule at depression rather than at narrower and less ambitious pathological or syndromic targets.

Type
Communication
Copyright
Copyright © European Psychiatric Association 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Cet article a fait l'objet d'une communication lors du symposium «sérotoninergie et dépression» à l'Institut Pasteur le 21 avril 1989.

References

Références

Brown, CSKent, TABryant, SGGevedon, RMCampbell, JLFelthous, ARBarratt, ESRose, RM (1989) Blood platelet uptake of serotonin in episodic aggression. Psychiatry Res 27, 512CrossRefGoogle ScholarPubMed
Delay, JDeniker, P (1961) Méthodes chimiothérapiques en psychiatrie. Masson, 15Google Scholar
De Wilde, J EMDoogan, DP (1982) Fluvoxanune and chlorimipramine in endogenous depression.. J Affective Disord 4, 249259CrossRefGoogle ScholarPubMed
Doogan, DPCaillard, V (1988) Sertraline in the prevention of relapse in major depression.Berlin, Psychopharmacology 96 (suppl), 271Google Scholar
Evans, LKenardy, JSchneider, P (1986) Effect of a selective serotonin uptake inhibitor in agoraphobia with panic attacks. A double blind comparison of zimelidine, imipramine and placebo. Acta Psychiatr Scand 73, 4953CrossRefGoogle ScholarPubMed
Ferguson, JM (1988) Fluoxetine-induced weight loss in overweight, nondepressed subjects. Am J Psychiatry, 143, 1496Google Scholar
Flament, MRapoport, JBerg, C (1987) Clomipramine treatment of childhood disorder. Arch Gen Psychiatry 42, 977983CrossRefGoogle Scholar
Gill, GKAmit, ZOgren, SO (1985) The effects of zimeldine on voluntary ethanol consumption: studies on the mechanism of action. Alcohol 2, 343347CrossRefGoogle ScholarPubMed
Goodman, WKPrice, LHRasmussen, SADelgado, PLHeninger, GRCharney, DSGoodman, WKPrice, LHRasmussen, SADelgado, PLHeninger, GRCharney, DS (1989) Efficacy of fluvoxamine in obsessive-compulsive disorder. A double-blind comparison with placebo. Arch Gen Psychiatry 46, 3644CrossRefGoogle ScholarPubMed
Harto, NESpera, KFBranconnier, RJ (1988) Fluoxetine-induced reduction of body mass in patients with major depressive disorder. Psychophartnacol Bull 2, 220223Google Scholar
Joyce, PRPaykel, ES (1989) Predictors of drug response in depression. Arch Gen Psychiatry 46, 8999CrossRefGoogle ScholarPubMed
Insel, TRMurphy, DLCohen, RM (1983) Obsessive compulsive disorder. A double-blind trial of clomipramine and clorgyline. Arch Gen Psychiatry 40, 605612CrossRefGoogle ScholarPubMed
Kahn, RSWesterberg, HG (1985) L-5-hydroxytryptophan in the treatment of anxiety disorders. J Affective Disord 8, 197200CrossRefGoogle ScholarPubMed
Kayser, ARobinso, DSYingling, KHoward, DBCorcella, JLaux, D (1988) The influence of panic attacks on response to phenelzine and amitriptyline in depressed outpatients. J Clin Psychopharmacol 4, 246253Google Scholar
Liebowitz, MRQuitkin, FMStewart, JWMcGrath, PJHarrison, WMMazrkowitz, JSRabkin, JGTricamo, EGoetz, DMKlein, DF (1988) Antidepressant specificity in atypical depression. Arch Gen Psychiatry 45, 129137CrossRefGoogle ScholarPubMed
Lopez-lbor, JJ Jr (1988) Implication de la sérotonine au cours de divers troubles psychiatriques et sur certains comportements. Br J Psychiatry 153 (Suppl, éd française), 2842Google Scholar
Montgomery, SADufour, HBrion, SGailledreau, JLaqueille, XFerrey, GMoron, PParant-Lucena, NSinger, LDanion, JMBeuzen, JNPierredon, MA (1988) Efficacité prophylactique de la fluoxétine dans la dépression unipolaire. Br J Psychiatry 153, 7584CrossRefGoogle Scholar
Murphy, GESimons, ADWetzel, RDLustman, PJ (1984) Cognitive therapy and pharmacotherapy ; singly and together in the treatment of depression. Arch Gen Psychiatry 41, 3341CrossRefGoogle ScholarPubMed
Naranjo, CASellers, EMRoach, CAWoodley, DVSanchez-Craig, MSykora, K (1984) Zimelidincinduced variations in alcohol intake by nondepressed heavy drinkers. Clin Pharmacol Ther 35, 374381CrossRefGoogle ScholarPubMed
Naranjo, CASellers, EMSullivan, JTWoodley, DVKadlec, KSykora, K (1987) The serotonin uptake inhibitor, citalopram, attenuates ethanol intake. Clin Pharmacol Ther 41, 266274CrossRefGoogle ScholarPubMed
Perse, TLGreist, JHJefferson, JWRosenfeld, RDar, R (1987) Fluvoxamine treatment of obsessive-compulsive disorder. Am J Psychiatry 12, 15431548Google Scholar
Price, LHGoodman, WKCharney, DSRasmussen, SAHeninger, GR (1987) Treatment of severe obsessive-compulsive disorder with fluvoxamine. Am J Psychiatry 8, 10591061Google Scholar
Rickels, KFeighner, JPSmith, WT (1985) Alprazolam, amitriptyline, doxepin and placebo in the treatment of depression. Arch Gen Psychiatry 42, 134141CrossRefGoogle ScholarPubMed
Rush, AJErman, MKSchlesser, MARoffwarg, HPVasavada, NKhatami, MFairchild, CGiles, DE (1985) Alprazolam vs amitriptyline in depressions with reduced REM latencies. Arch Gen Psychiatry 42, 11541159CrossRefGoogle ScholarPubMed
Sellers, EMNaranjo, CAKadlec, K (1987) Do serotonin uptake inhibitors decrease smoking? Observations in a group of heavy drinkers. J Clin Psychopharmacol 6, 417420Google Scholar
Sheehan, DVZak, JPMiller, JAFanous, BSL (1988) Panic disorder : the potential role of serotonin reuptake inhibitors. J Clin Psychiatry 49, 3036Google ScholarPubMed
Zak, JPMiller, JA JrSheehan, DVFanous, BSL (1988) The potential role of serotonin reuptake inhibitors in the treatment of obsessive compulsive disorder. J Clin Psychiatry 49, 2329Google ScholarPubMed
Zohar, JInsel, TR (1987) Drug treatment of obsessive compulsive disorder. J Affective Disord 13, 193202CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.